Bone marrow lesions in osteoarthritis: From basic science to clinical implications

Shi, Xiaorui; Mai, Yiying; Fang, Xiaofeng; Wang, Zhiqiang; Xue, Song; Chen, Haowei; Dang, Qin; Wang, Xiaoshuai; Tang, Simin; Ding, Changhai; Zhu, Zhaohua

doi:10.1016/j.bonr.2023.101667

Cited by 5 publications

(4 citation statements)

References 117 publications

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“…On the other hand, the OST ROIs demonstrate intermediate results. Texture variations may originate from the necrosis, fibrosis, and trabeculae differentiations [3] and local subchondral changes in BMLs [8,41].…”

Section: Resultsmentioning

confidence: 99%

“…There is evidence that subchondral BMLs imaged using MRI are involved in the pathogenesis of OA [4,5,7,8]. BME pattern is defined as an area of high signal intensity in T2-weighted, fat-saturated MRI or in short-inversion-time inversion recovery (STIR) 2 of 13 images [9][10][11].…”

Section: Introductionmentioning

confidence: 99%

“…Regarding healthy subjects with no OA, traumatic injuries of the knee can result in subchondral bone edema lesions [12,13]. However, the causal relationship between these lesions and the disease's progression is unclear [8]. A better understanding of the interrelation of cartilage and the bone immediately under is necessary [14].…”

Section: Introductionmentioning

confidence: 99%

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Radiomics Texture Analysis of Bone Marrow Alterations in MRI Knee Examinations

Kostopoulos,

Boci,

Cavouras

et al. 2023

J. Imaging

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Accurate diagnosis and timely intervention are key to addressing common knee conditions effectively. In this work, we aim to identify textural changes in knee lesions based on bone marrow edema (BME), injury (INJ), and osteoarthritis (OST). One hundred and twenty-one MRI knee examinations were selected. Cases were divided into three groups based on radiological findings: forty-one in the BME, thirty-seven in the INJ, and forty-three in the OST groups. From each ROI, eighty-one radiomic descriptors were calculated, encoding texture information. The results suggested differences in the texture characteristics of regions of interest (ROIs) extracted from PD-FSE and STIR sequences. We observed that the ROIs associated with BME exhibited greater local contrast and a wider range of structural diversity compared to the ROIs corresponding to OST. When it comes to STIR sequences, the ROIs related to BME showed higher uniformity in terms of both signal intensity and the variability of local structures compared to the INJ ROIs. A combined radiomic descriptor managed to achieve a high separation ability, with AUC of 0.93 ± 0.02 in the test set. Radiomics analysis may provide a non-invasive and quantitative means to assess the spatial distribution and heterogeneity of bone marrow edema, aiding in its early detection and characterization.

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Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Radiomics Texture Analysis of Bone Marrow Alterations in MRI Knee Examinations

Kostopoulos,

Boci,

Cavouras

et al. 2023

J. Imaging

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“…Moreover, aging and OA share several common characteristics, including the imbalance between reactive oxygen species production and the ability to repair tissue damages through endogenous antioxidant defenses. This may increase oxidative stress and further alter the bone microenvironment [ 41 ], which plays a key role in the formation of BMLs [ 42 ]. Additionally, a previous study also found that obesity was a risk factor of BMLs [ 43 ], and it is possible that this is due to biomechanical or metabolic mechanisms [ 44 , 45 ].…”

Section: Discussionmentioning

confidence: 99%

Factors associated with trajectories of bone marrow lesions over 4 years: data from the Osteoarthritis Initiative

Shen,

Zhang,

Wang

et al. 2024

Skeletal Radiol

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Objective To identify bone marrow lesion (BML) trajectories over 4 years and their demographic and structural predictors in middle-aged and older adults with or at increased risk of knee osteoarthritis (OA). Methods A total of 614 participants (mean age 61 years, 62% female) from the Osteoarthritis Initiative cohort (OAI) were included. BMLs in 15 anatomical locations of the knee were measured annually from baseline to 4 years using the Magnetic Resonance Imaging Osteoarthritis Knee Score (MOAKS) method. BML trajectories were determined using latent class mixed models (LCMMs). Multinomial logistic regression was used to examine baseline characteristics that predicted BML trajectories. Results Three distinct BML trajectories were identified: “Mild-stable BMLs” (25.9%), “Moderate-stable BMLs” (66.4%), and “Rapid-rise BMLs” (7.7%). Compared to the “Mild-stable BMLs” trajectory, current smokers were more likely to be in the “Moderate-stable BMLs” (odds ratio [OR] 2.089, P < 0.001) and “Rapid-rise” (OR 2.462, P < 0.001) trajectories. Moreover, female sex and meniscal tears were associated with an increased risk of being in the “Rapid-rise BMLs” trajectory (OR 2.023 to 2.504, P < 0.05). Participants who had higher education levels and drank more alcohol were more likely to be in the “Rapid-rise BMLs” trajectory (OR 1.624 to 3.178, P < 0.05) and less likely to be in the “Moderate-stable BMLs” trajectory (OR 0.668 to 0.674, P < 0.05). Conclusions During the 4-year follow-up, most participants had relatively stable BMLs, few had enlarged BMLs, and no trajectory of decreased BMLs was identified. Sociodemographic factors, lifestyle, and knee structural pathology play roles in predicting distinct BML trajectories.

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The severity of preoperative bone marrow oedema negatively influences short‐term clinical outcomes following arthroscopic bone marrow stimulation for osteochondral lesions of the talus

Li,

Fan,

Zhou

et al. 2024

Knee surg. sports traumatol. arthrosc.

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PurposeThe purpose of this study was to study the effects of the severity of preoperative bone marrow oedema (BME) on the postoperative short‐term outcomes following bone marrow stimulation (BMS) for osteochondral lesions of the talus (OLTs) and to propose a new metric that combines volume and signal density to evaluate BME.MethodsSixty‐five patients with symptomatic OLTs (<100 mm2) and preoperative BME, who received BMS in our institution from April 2017 to July 2021 with follow‐ups of 3, 6 and 12 months, were analysed retrospectively. The area, volume and signal value of the BME were collected on preoperative magnetic resonance imaging. The enroled patients were divided into two groups according to the BME index (BMEI), which was defined as the product of oedema relative signal intensity and the relation of oedema volume to total talar volume. Visual analogue scale, American Orthopedic Foot and Ankle Society (AOFAS), Tegner, Foot and Ankle Ability Measure (FAAM)–activities of daily living (ADL) and Sports scores were assessed before surgery and at each follow‐up. The relationship between the scores and the volume, relative signal intensity and BMEI was explored.ResultsSixty‐five patients with preoperative BME were divided into the mild (n = 33) and severe (n = 32) groups based on the BMEI. A significant difference was found for each score with the general linear model for repeated measures through all follow‐up time points (p < 0.001). For the preoperative and 12‐month postoperative changes of the enroled patients, 53 patients (81.5%) exceeded the minimal clinically important difference of AOFAS and 26 (40.0%) exceeded that of FAAM‐sports in this study. The mild group showed significantly more improvement in AOFAS scores at 12 months (89.6 ± 7.0 vs. 86.2 ± 6.2) and FAAM‐ADL scores at 6 months (83.6 ± 7.6 vs. 79.7 ± 7.7) and 12 months (88.5 ± 8.5 vs. 84.4 ± 7.7) than the severe group (p < 0.05). No significant difference of all the scores between the groups was found at 3 months. No significant correlation was found in each group between BMEI and clinical outcomes.ConclusionThe severity of the preoperative BME negatively affected short‐term clinical outcomes following arthroscopic BMS for OLTs. Worse clinical outcomes were shown at postoperative 6 and 12 months in patients with a high preoperative BMEI, which could be a favourable parameter for assessing the severity of BME and assist in developing personalised rehabilitation plans and determining the approach and timing of surgery.Level of EvidenceLevel III.

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Bone marrow lesions in osteoarthritis: From basic science to clinical implications

Cited by 5 publications

References 117 publications

Radiomics Texture Analysis of Bone Marrow Alterations in MRI Knee Examinations

Radiomics Texture Analysis of Bone Marrow Alterations in MRI Knee Examinations

Factors associated with trajectories of bone marrow lesions over 4 years: data from the Osteoarthritis Initiative

The severity of preoperative bone marrow oedema negatively influences short‐term clinical outcomes following arthroscopic bone marrow stimulation for osteochondral lesions of the talus

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